Aetna, Cleveland Clinic Form Low Cost, Narrow Network Health Plan

CVS Health’s Aetna has formed a new partnership with Cleveland Clinic which involves a new narrow network health plan and new provider programs, the payer and provider announced.

“As part of CVS Health’s goal of becoming the most consumer-centric health company, we are facilitating access to high-quality health care where and when consumers need it,” said Angie Meoli, senior vice president of network strategy and provider experience at Aetna.

“Cleveland Clinic is renowned for delivering exceptional health care, and our new collaboration will enable our members to receive the personalized and coordinated care they need to get and stay healthy.”

The partnership is an Aetna Whole Health partnership. Aetna Whole Health partners with accountable care organizations to offer value-based care products. Operating on this value-based care model, Aetna will reward the Cleveland Clinic for abiding by established cost and quality measures.

Members will be assigned a care manager from Aetna who will arrange their personalized, coordinated care.

Aetna members will have access to the Cleveland Clinic Quality Alliance network. This network encompasses independent community physicians, employed physicians, and Cleveland Clinic facilities across the northeast Ohio area.

In 2019, Cleveland Clinic boasted over 11 hospitals in the northeast Ohio area and 51,731 caregivers across the state. The clinic is an academic medical center, engaging in both clinical care and research.

Cleveland Clinic and Aetna will also offer a new virtual care program so that Aetna members can access specialty and second opinion services with a specialty referral line.

The narrow network health plan offers an alternative to Aetna’s broad network plans.

“The Aetna Whole Health–Cleveland Clinic plan provides employers a cost-effective offering beyond Aetna’s typical broad network plans, while also giving members access to Cleveland Clinic’s care providers,” the press release explained.

Recent research has shown that members are willing to pay a $72 premium to obtain a provider network that is 30 percent broader, according to a survey published in the American Journal of Managed Care.

After considering quality and cost, 30 percent of employers, like their employees, would choose a health plan largely based on the breadth of the provider network and 39 percent said that they would not narrow their network even to save on healthcare spending, a Kaiser Family Foundation (KFF) survey revealed.

Payers, in contrast, who tend to prioritize incentivizing lower healthcare spending, typically face two options, KFF indicated: narrowing networks or increasing cost-sharing.

Thus, while employers may be more inclined to select broad network over pricing to cater to employees’ preferences, some employers find themselves having to consider narrower networks in order to control healthcare spending.

More than a third of employers who responded to a PricewaterhouseCooper consumer survey said that they would switch to a narrow network health plan if the price was lower.

That is likely why Aetna emphasized its potential cost-savings estimate for employers that join its new health plan.

While Aetna has health plans with broad networks available in the Ohio area, the payer and its clinical partner expect that the new narrow network health plan will decrease employer healthcare spending by up to 10 percent more than an existing Aetna broad network health plan.

The health plan achieves this by closing gaps in care, Meoli told HealthPayerIntelligence in an emailed statement.

“The product leverages Cleveland Clinic’s excellence in quality and outcomes, while integrating with Aetna’s Clinical Transformation team and reporting capabilities to close gaps in care,” said Meoli. “By narrowing the network of providers, Cleveland Clinic can better engage and manage the member’s total cost of care.”

The health plan becomes available to fully insured and self-insured employers in eligible areas of the state in autumn 2020.

Other programs that the partnership will encompass include a cardiac center of excellence program. Aetna plans nationwide can send patients to Cleveland Clinic for cardiac care.

“Both organizations are committed to continue working on new initiatives to bring innovative, transformative, and cost-effective care to local communities,” the press release promised.

This partnership is not the first major development for Aetna Whole Health in 2020.

Earlier this year, Aetna Whole Health announced a new partnership with two accountable care organizations in Georgia. The partnership granted members access to 900 primary doctors, 3,500 specialists, 14 hospitals, and more than 500 outpatient facilities in Atlanta area, all of whom were engaged in upside risk with Aetna Whole Health.